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The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. Photos courtesy Rajiv Patel - ROOTS
  Forked tongue cases!

From: Rajiv Patel
To: ROOTS
Sent: Saturday, June 20, 2009 5:48 PM
Subject: [roots] Forked tongue cases!

Had 2 in a week with these forked apical splits. Had to squirt 
the Db canal on the maxillary molar - while hand instrumentation 
could sense multiple apical picks during recaps.
The mandibular molar was reasonably easier...(; -  Rajiv Patel

Forgot to add this from the same week - 3 visits on a premolar with a deep split. Some times you gotta use your finger (seen in radiograph) to get a decent rad. This fine lady was missing her canines and had a shallow palate - any suggestions for getting better radiographs on these without being in the line of fire?? - Rajiv

Rajiv,'the way to get off line of fire is to push somebody else in there :-) Usually it could be..guess who?... the patient :-) - Dmitri Superb! - RafaŽl beautiful work Rajiv - Imran Hi Rajiv, Beautiful work as usual ! Do your referrals have a problem with you doing the permanent restoration? I still have your presentation on "coronal seal" :-))) - Siju Thanks Siju. You are right Siju - there are some referrrals who have a preference to place the permanent restoration. We have a list of referrals who want us to place the seal. It can be a very sensitive topic to broach...but as endodontists we are known to get on other people's NERVES... (; - Rajiv Very Nice. What radiography system do you use? - Roman Bakowicz It's a Schick system. Thanks for your comments - Rajiv Dr.Patel: Wonderfull shapings. Could you describe for us your instrument sequence for the mesials canals of the treated first inferior molar? - Laura Thanks Laura. Here is my not so fancy instrumentation - Shaping and cleaning not so rigid regimen: 1. Checking /Scouting for canal curvatures with small hand files -6,8,10 2. Use hand instruments in a crown down manner - makes it easy for smaller files to gain length easily 3. Gates - 3 & 2 mainly and occassionally 4 4. Create a glide path to atleast a 20 with hand files prior to using a rotary - I use Protapers and Profiles and supplement with them patency files after every rotary use to maintain patency- Lots of irrigation and at times Endoactivator to activate irrigation 5. In severe apical curves - prebending your files helps a lot, in some cases I do use the reciprocating hand piece - not this one! The main TIP is TIME, INTENTION + PATIENCE - Rajiv Patel Dear Dr. Patel: Thanks to you very much for your response. Two more questions please: 1.- I would like to know if you use the rotatory Protapers or Profiles only in a rotational way or sometimes you use them with a reciprocating handpiece, like M4 or Endo Eze. 2.- Safe prebending the files: Do you use prebend in this case: Flexo-files, K-files, Niti-files and till what number of files: 25, 30 ? Also Protapers or Profiles? - Laura Hi Laura, I haven't tried using Protapers in a reciprocating handpiece....may be I am missing out..(: I do use them sometimes for hand instrumentation and prebend them if necessary. And to your 2nd question - I do pre-bend K- files keeping in mind the previous curvatures obtained from the "scouters" - smaller files (6,8,10..) Again in tight curves - it will take repeated pre-bending to maintain the curvatures. Sometimes in these tight/acute curvatures - my experience is that there is a compromise if your intention is to obtain large apical sizes - you risk altering the anatomy. Hence it will be case to case with respect to apical size - Rajiv Patel Hey Kendo, Yes - 3.7/ # 18 has been treatment planned for sunshine and cold steel due to a all the signs of a crack .The patient and the referral are both aware of it, the patient wanted to wait untill 4th of July fireworks for the extraction.....);. - Rajiv I love the cases and the TIP too, Rajiv - Nuria

K 3 lightspeed

Crown replacement

Root reinforcement

Vertical root fracture

Periodontal pocket

Cox crapification

Cold sensitivity

Buccal sinus

Nikon 995

Distal canals

Second mesial canal

Narrow escape

Membrane

Severe curvatures

Unusual resorption

Huge pulpstone

Molar access

Perforation repair

Maxillary molars

Protaper shaping

Pulsing pain

Apical periodontitis

Mesial middle

Isthmus protocol

Fragment beyond apex

Apical trifurcation

Jammed K file

Mesial canals

Irreversible pulpitis

Bicuspid abscess

Sideways molar

Red Dye allergy

Small mirrors

Calcified molar

Extraction and implants

Calcificated central

Internal resorption

Bone lucency

Porcelain inlay

Bone allograft